Personal Perspective: HIV- UB2?

"Are you clean?" I looked down at the guy who was asking me this. As opposed to what, I wondered. Dirty? Well, I did take a shower before I left the house. So, yeah, I was clean.

You see, I had been talking to this guy on a phone sex line (this was before internet hookups) for almost an hour when he invited me out to his house in Brooklyn -- at two in the morning. All he wanted was to have oral sex, he said. The subway ride took about an hour, with a ten-block walk to his house. And after all that, just before we were ready to start, he decides to try to find out my HIV status.

It wasn't the first time I'd experienced this. And, of course, guys never ask, "Do you have HIV?" It's always a dodge: "Are you safe?" "Are you healthy?" And the most insulting, the one this guy used: "Are you clean?"

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Just what exactly do these guys think they're doing? Protecting themselves? Gimme a break. I think the response of many guys with HIV is, "Which answer gets me a blow job?" Do people actually think the information they get from a stranger is in any way useful? Especially when that guy wants sex right now?

That's why I've been upset by recent efforts to encourage "serosorting" (having sex only with people of the same HIV status). Serosorting works fine if you are HIV positive. Many people with HIV choose to have sex only with other people with HIV. It eliminates the "disclosure moment" and also the need for condoms, if you aren't concerned about superinfection with a second strain of HIV (most documented cases of which have occurred within two years of a person's initial HIV infection).

Serosorting for people in long-term relationships is another matter (I'll get to that later), but encouraging HIV-negative gay men to ask strangers their HIV status is not only useless, it's dangerous. Here's why.

First, the information is arguably worthless. Someone you barely know has little motivation to be honest, since no personal or emotional bond exists. And even if someone thinks he's negative, he could be wrong. He may have been tested two years ago, or he may have been infected last week (in which case he would have an incredibly high viral load, increasing the risk of infection). Relying on the self-reporting of someone you barely know when making a decision about safer sex is foolish at best. Recent studies have shown that a significant number of new infections are occurring during the "window" period -- the time when someone who is newly infected still tests HIV negative (up to three months).

Second, it's dangerous. If the guy claims to be negative, do you then do things you wouldn't do with someone who is positive? For many, the answer is yes. Guys who avoid even low-risk behavior -- like oral sex without ejaculation -- will do that with someone who claims to be negative. But believing a stranger is negative can remove a lot of inhibitions, leading to really unsafe behavior, like anal sex without a condom. So, in the end, asking HIV status and making decisions about what you will do based on the answer can actually lead to higher-risk behavior than not asking.

Third, if you reject people who admit to being positive, you may encourage them to lie the next time. And some guys can be brutal, as anyone who is positive knows. I've been with guys who were clearly ready to have anal sex without a condom. But when I ask, "Are you positive?" and they say no, the sex is over once I say that I am. And I mean over -- no touching, no kissing, nothing. Yet the guy who is too scared even to kiss a guy with HIV had been eager to have anal sex without a condom before I spoke up.

As someone with HIV I believe I have an obligation to behave responsibly and not infect others. I've had a number of negative boyfriends, and they are all still negative. In fact, only one guy I dated had a bad reaction when I disclosed my status. My current boyfriend and I have had great sex for five years, and he remains negative. (This isn't rocket science, folks -- we just use a condom!) I wouldn't agree to oral sex without a condom until he was fully informed about the (low) risk and had made a sober decision to do it, a decision not made in the heat of passion.

But it can be difficult to feel compassion for strangers who will often be cruel once we disclose our status. And guys who ask "the HIV question" can be surprisingly thoughtless. I've had guys come up to me in a bar and within two minutes pop the "Are you healthy?" question. Now, wait a minute! I may not even be interested in this guy, but I'm supposed to start disclosing my medical history to him? The sense that something as personal as your HIV status is public information never ceases to amaze me.

With the rise of the internet, attempted serosorting seems to have really taken off. Many online ads post cold warnings: "Disease-free only" or "HIV- UB2." And most gay male hookup sites require you to post something about your HIV status. I put up an ad at one site and was required to choose "Negative, Positive, Unknown, or No Answer" for my HIV status. I chose "No Answer" and got very few come-ons. So, as an experiment, I changed my status to "Negative."

Sure enough, I suddenly began getting a bunch of hits. And when I spoke to them on the phone, it was clear many of them were looking for bareback sex (anal sex without a condom). In spite of the overhyped stories about barebackers looking to get infected, I've found that the vast majority of HIV-negative gay men -- including those who bareback intentionally -- are quite concerned about avoiding HIV, and people with it.

It's good that negative men want to stay negative -- we need to help them find ways to do that. But trying to screen out all people with HIV via interrogation is nothing more than a fantasy. I actually had one guy say he could tell if someone was lying about their status by looking into their eyes when he asked. Hello?

And this is not only about sex with strangers. Many gay men take off the condoms just a few weeks into a relationship, with little or no discussion of the risk. I knew a 22-year-old who had fallen in love with his dream boyfriend. He asked him if he was negative, and was assured that he was. They took off the condoms, and now he's positive. So if you can't trust even the information you get from someone you're in love with, how can you trust information from someone you meet on the internet?

There are recommendations for couples who want to take off the rubbers, and I agree with them: get tested together, and if you're both negative, work out an agreement on either being monogamous or being safe with outside partners. And most especially, be able to be honest with each other if one of you slips and has unsafe sex with a stranger. You each must explicitly agree that if one of you admits to being with someone else, you will engage in a frank and honest conversation, and not just start screaming and end the relationship. Of course, this approach involves accepting a certain level of risk, and in a way puts your life and health in the hands of your partner. And that takes a lot of talking, a lot of trust, and a lot of caring -- something you're not going to find in someone you meet at a bar or online.

If you choose to have casual sex, you must decide what you are comfortable doing with someone who is positive and then do that with everyone. If you won't have sex with someone who is positive, don't do it with a stranger just because he assures you he's "really" negative.

It's unfortunately true that more gay men are choosing to be unsafe, but letting them think they can screen out HIV-positive partners or suggesting "harm reduction" for barebacking (see Harm Reduction for Barebacking?) is not the answer. Maybe letting them know that people with HIV are not lepers and that safer sex is doable is one approach. It's certainly better than letting the fantasy of serosorting lead to seroconversion.

Mark Milano, who always showers before sex, is an HIV treatment educator and editor of ACRIA Update.

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